POS1018 DRUG SURVIVAL AND TREATMENT RESPONSE RATES IN PSORIATIC ARTHRITIS PATIENTS SWITCHING TO FIRST- OR SECOND-LINE IL-17 INHIBITOR TREATMENT: A DANISH POPULATION-BASED COHORT STUDY
Authors: R. L. Hansen, T. S. Jørgensen, A. Egeberg, N. Lippert Rosenoe, M. Skougaard, Z. R. Stisen, L. Dreyer, L. E. Kristensen
Journal: Annals of the Rheumatic Diseases (2022)

Background Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy associated with psoriasis [1]. It is defined as a multifaceted chronic inflammatory disease with chronic peripheral and/or axial arthritis, enthesopathy and dactylitis. PsA patients also experience fatigue, decreased physical functions and sleep disturbances, which may result in impaired social activity and decreased work productivity [2, 3]. All of these disease associated symptoms can cause substantial functional and mental impairment and thereby result in decreased quality of life [4-5]. Patient impacting factors are important when trying to further understand the disease and when choosing a treatment option to properly manage the symptoms of PsA [2]. Objectives The objective of this study was to assess the effectiveness of switching to a first- or second-line IL-17 inhibitor treatment in patients with PsA from 2014 to 2021, using data from the Danish Rheumatology registry (DANBIO) by investigating drug survival and treatment response rates. Methods PsA patients recorded in DANBIO who switched to a first- or second-line IL-17 inhibitor treatment from a previous biologic disease-modifying antirheumatic drugs (bDMARD) between 2014 and 2021 were included in this study. Baseline characteristics were analyzed in subgroups: first-line IL-17 inhibitor treatment and second-line IL-17 inhibitor treatment and presented as median and interquartile ranges or number and percentage. Visual analog scale (VAS) fatigue 50% improvement and VAS pain 50% improvement, Disease Activity Scores-28 C-reactive protein (DAS-28-CRP) remission and ΔDAS28 scores at 6- and 12-months follow-up was reported. Drug survival of first- or second-line IL-17 inhibitor treatment was reported as a Kaplan Meier plot. Results 583 patients were identified and included in the study. Baseline characteristics (Table 1) showed that the age, percentage of females, CRP, HAQ, VAS patient pain, VAS global and DAS28CRP in both first- and second-line IL-17 inhibitor treatment was comparable. First- and second-line IL-17 inhibitor treatment had almost identical drug survival (Figure 1). Table 1. First-line IL-17 inhibitor n= 434 Second-line IL-17 inhibitor n= 97 Age, years 51.0 (49.6-52.3) 51.9 (46.4-54.7) Female, % (n) 59.0 (256) 53.6 (52) Disease duration, years 6.8 (6.1-7.8) 8.2 (6.5-12.6) CRP, mg/dl 4.0 (4.0-5.2) 3.0 (2.9-5.3) HAQ 1.1 (1.1-1.3) 1.0 (0.9-1.3) VAS pain, 100 mm 68 (65-72) 73 (66-76) VAS global, 100 mm 75 (73-78) 80 (75-88) DAS28-CRP 4.0 (3.8-4.1) 4.2 (3.7-4.6) Previous bDMARD 2.0 (1.0-3.0) 4.0 (2.0-5.5) CRP: C-reactive protein, HAQ: Health Assessment Questionnaire, VAS: Visual analog scale, DAS28: 28-joint Disease Activity Score, DMARD: disease-modifying antirheumatic drug. Figure 1. Conclusion PsA patients switching to a first- or second-line IL-17 inhibitor showed comparable baseline characteristics and an almost identical drug survival. Thus, treatment failure of a first-line IL-17 inhibitor treatment, should not block for a second-line IL-17 inhibitor treatment. References [1]Ritchlin, C.T., R.A. Colbert, and D.D. Gladman, Psoriatic Arthritis. N Engl J Med, 2017. 376 (21): p. 2095-6. [2]Ogdie, A., L.C. Coates, and D.D. Gladman, Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford), 2020. 59 (Suppl 1): p. i37-i46. [3]Orbai, A.M., et al., International patient and physician consensus on a psoriatic arthritis core outcome set for clinical trials. Ann Rheum Dis, 2017. 76 (4): p. 673-680. [4]Kristensen, L.E., et al., Effectiveness and Feasibility Associated with Switching to a Second or Third TNF Inhibitor in Patients with Psoriatic Arthritis: A Cohort Study from Southern Sweden. J Rheumatol, 2016. 43 (1): p. 81-7. [5]Jørgensen, T.S., et al., Relation Between Fatigue and ACR Response in Patients With Psoriatic Arthritis Treated With Tumor Necrosis Factor Inhibitor Therapy: A Population-based Cohort Study. J Rheumatol, 2020. Disclosure of Interests Rebekka L. Hansen: None declared, Tanja Schjødt Jørgensen Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Biogen and Eli Lilly, Alexander Egeberg Speakers bureau: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Consultant of: AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals, Grant/research support from: Pfizer, Eli Lilly, Novartis, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, Nana Lippert Rosenoe: None declared, Marie Skougaard Grant/research support from: Eli Lilly and Pfizer, Zara Rebecca Stisen: None declared, Lene Dreyer Speakers bureau: MSD, UCB and Janssen Pharmaceuticals, Consultant of: MSD, UCB and Janssen Pharmaceuticals, Lars Erik Kristensen Speakers bureau: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals, Consultant of: Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen pharmaceuticals